Efficacy of phage therapy in preclinical models of bacterial infection: a systematic review and meta-analysis.

BACKGROUND: Antimicrobial resistance of bacterial pathogens is an increasing clinical problem and alternative approaches to antibiotic chemotherapy are needed. One of these approaches is the use of lytic bacterial viruses known as phage therapy. We aimed to assess the efficacy of phage therapy in preclinical animal models of bacterial infection. METHODS: In this systematic review and meta-analysis, MEDLINE/Ovid, Embase/Ovid, CINAHL/EbscoHOST, Web of Science/Wiley, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Google Scholar were searched from inception to Sept 30, 2021. Studies assessing phage efficacy in animal models were included. Only studies that assessed the efficacy of phage therapy in treating established bacterial infections in terms of survival and bacterial abundance or density were included. Studies reporting only in-vitro or ex-vivo results and those with incomplete information were excluded. Risk-of-bias assessment was performed using the Systematic Review Centre for Laboratory Animal Experimentation tool. The main endpoints were animal survival and tissue bacterial burden, which were reported using pooled odds ratios (ORs) and mean differences with random-effects models. The I2 measure and its 95% CI were also calculated. This study is registered with PROSPERO, CRD42022311309. FINDINGS: Of the 5084 references screened, 124 studies fulfilled the selection criteria. Risk of bias was high for 70 (56%) of the 124 included studies; therefore, only studies classified as having a low-to-moderate risk of bias were considered for quantitative data synthesis (n=32). Phage therapy was associated with significantly improved survival at 24 h in systemic infection models (OR 0·08 [95% CI 0·03 to 0·20]; I2=55% [95% CI 8 to 77]), skin infection (OR 0·08 [0·04 to 0·19]; I2 = 0% [0 to 79]), and pneumonia models (OR 0·13 [0·06 to 0·31]; I2=0% [0 to 68]) when compared with placebo. Animals with skin infections (mean difference -2·66 [95% CI -3·17 to -2·16]; I2 = 95% [90 to 96]) and those with pneumonia (mean difference -3·35 [-6·00 to -0·69]; I2 = 99% [98 to 99]) treated with phage therapy had significantly lower tissue bacterial loads at 5 ±â€ˆ2 days of follow-up compared with placebo. INTERPRETATION: Phage therapy significantly improved animal survival and reduced organ bacterial loads compared with placebo in preclinical animal models. However, high heterogeneity was observed in some comparisons. More evidence is needed to identify the factors influencing phage therapy performance to improve future clinical application. FUNDING: Swiss National Foundation and Swiss Heart Foundation.

Cardiovascular biomarkers as predictors of adverse outcomes in chronic Chagas cardiomyopathy.

BACKGROUND: Chronic Chagas Cardiomyopathy (CCM) is a unique form of cardiomyopathy compared to other etiologies of heart failure. In CCM, risk prediction based on biomarkers has not been well-studied. We assessed the prognostic value of a biomarker panel to predict a composite outcome (CO), including the need for heart transplantation, use of left ventricular assist devices, and mortality. METHODS: Prospective cohort study of 100 adults with different stages of CCM. Serum concentrations of amino-terminal pro-B type natriuretic peptide (NT-proBNP), galectin-3 (Gal-3), neutrophil gelatinase-associated lipocalin (NGAL), high sensitivity troponin T (hs-cTnT), soluble (sST2), and cystatin-C (Cys-c) were measured. Survival analyses were performed using Cox proportional hazard models. RESULTS: During a median follow-up of 52 months, the mortality rate was 20%, while the CO was observed in 25% of the patients. Four biomarkers (NT-proBNP, hs-cTnT, sST2, and Cys-C) were associated with the CO; concentrations of NT-proBNP and hs-cTnT were associated with the highest AUC (85.1 and 85.8, respectively). Combining these two biomarkers above their selected cut-off values significantly increased risk for the CO (HR 3.18; 95%CI 1.31-7.79). No events were reported in the patients in whom the two biomarkers were under the cut-off values, and when both levels were above cut-off values, the CO was observed in 60.71%. CONCLUSION: The combination of NT-proBNP and hs-TnT above their selected cut-off values is associated with a 3-fold increase in the risk of the composite outcome among CCM patients. The use of cardiac biomarkers may improve prognostic evaluation of patients with CCM.

Complicaciones postransfusionales en pacientes pediátricos con leucemia / Post-transfusion complications in pediatric patients with leukemia

Introducción: El cáncer pediátrico es un importante problema de salud pública y el más frecuente es la leucemia. En ocasiones, esta enfermedad puede generar depleción de las líneas celulares y es la transfusión de hemocomponentes un importante pilar de su tratamiento. Este procedimiento puede generar reacciones postransfusionales que pueden ser letales. Objetivo: Exponer las diferentes características clínicas y epidemiológicas de las reacciones postransfusionales en población pediátrica con leucemia. Métodos: Se realizó una búsqueda sistemática en las principales bases de datos de literatura médica. Se incluyeron 46 artículos. Resultados: La complicación más frecuente es la reacción febril no hemolítica. También es frecuente la sobrecarga de hierro. El factor de riesgo más importante para presentar esta sobrecarga es el número de transfusiones. Es necesario monitorizar la cantidad de hierro hepático. La reacción pulmonar aguda relacionada con la transfusión es una condición potencialmente mortal. Las infecciones pueden presentarse y pueden ser mortales dada la inmunosupresión de este grupo de pacientes. Otras reacciones inmunológicas pueden ser raras, pero deben ser tenidas en cuenta. Consideraciones finales: Las reacciones postransfusionales pueden ser más graves en los pacientes con leucemia. Se requiere realizar estudios con modelos epidemiológicos adecuados para identificar las reacciones postransfusionales más frecuentes en población pediátrica con esta enfermedad(AU)

Introduction: Pediatric cancer is a major public health problem and leukemia is the most common. Sometimes this disease can lead to depletion of cell lines and the transfusion of blood components is an important pillar of their treatment. This procedure can generate post-transfusion reactions that can be lethal. Objective: Show the different clinical and epidemiological characteristics of post-transfusion reactions in pediatric population with leukemia. Methods: A systematic search was carried out in the main databases of medical literature. 46 items were included. Results: The most common complication is the non-hemolytic febrile reaction. Iron overloading is also common. The most important risk factor for this overload is the number of transfusions. It is necessary to monitor the amount of iron in the liver. Acute transfusion-related pulmonary reaction is a life-threatening condition. Infections can occur and can be fatal given the immunosuppression of this group of patients. Other immune reactions may be rare, but they should be taken into account. Final considerations: Post-transfusion reactions may be more severe in patients with leukemia. Studies with appropriate epidemiological models are required to identify the most common post-transfusion reactions in the pediatric population with this disease(AU)

Luxación de la articulación temporomandibular: apropósito de un caso y su diagnóstico diferencial / Luxation of the temporomandibular joint: about a case report and its differential diagnosis

Resumen La luxación temporomandibular es infrecuente, pero genera gran repercusión en el esqueleto facial. En ocasiones el cuadro clínico inicial es inespecífico y puede confundirse con otras patologías si no se tiene un adecuado conocimiento del tema, o se realiza una anamnesis incorrecta. Este artículo presenta el caso de una paciente que consultó al servicio de urgencias por disartria y desviación de la comisura labial hacia la izquierda, asociado a dolor severo y parestesia en hemicara derecha. No obstante, al ingreso la paciente refirió síntomas ambiguos, que para el médico evaluador sugirieron una causa neurológica. Durante la observación se solicitó valoración por servicio de cirugía plástica, se logró orientación de la anamnesis y examen físico, obteniendo una impresión diagnóstica de luxación de articulación temporomandibular derecha, confirmada por imagenología, y por ende un tratamiento oportuno con reducción e inmovilización en el servicio de urgencias. MÉD.UIS.2019;32(3):49-54

Abstract The temporomandibular joint dislocation is uncommon, but it causes a great repercussion on the facial skeleton. Occasionally, the initial symptoms can be unspecific and confuse with other pathologies if there are not an adequate knowledge of the topic and the anamnesis is incorrect. This article presents a clinical case of a patient with dysarthria and left deviation of the labial commissure, associated with severe pain and paresthesia in the right side of the face. Nevertheless, the patient initially referred ambiguous symptoms, suggesting a neurological cause. During observation in the emergency room, plastic surgery service valorated the patient, with subsequent orientation of the anamnesis and physical examination, achieving a satisfactory management of the acute dislocation. MÉD.UIS.2019;32(3):49-54

Dermatomiositis asociada al cáncer de mama: características clínicas, complicaciones y tratamiento / Dermatomyositis associated with breast cancer: Clinical characteristics, complications and treatment

Resumen El cáncer de mama es un importante problema de salud pública. Aunque es infrecuente, uno de los síndromes paraneoplásicos del cáncer de seno es la dermatomiositis. Es necesario que el clínico tenga conocimientos sobre cómo diagnosticarla y tratarla adecuadamente. El objetivo de este artículo es realizar una revisión de la literatura sobre la clínica, complicaciones y tratamiento de la dermatomiositis en el cáncer de mama. Se realizó una búsqueda en diferentes bases de datos electrónicas, incluyendo un total de 34 artículos, abarcando ensayos clínicos aleatorizados, metaanálisis, artículos originales descriptivos y analíticos y reportes de caso. La dermatomiositis puede presentarse antes, durante, o después del cáncer de mama. Son frecuentes las complicaciones pulmonares, que pueden llegar a ser letales. La dermatomiositis aumenta las complicaciones por radioterapia y la mortalidad en los pacientes con cáncer de seno. El tratamiento farmacológico consiste en la aplicación de glucocorticoides a dosis según necesidad del paciente. MÉD.UIS. 2018;31(2):41-7.

Abstract Breast cancer is an important public health problem. Dermatomyositis is an infrequent paraneoplastic syndrome of breast cancer. It is necessary that the clinician has knowledge on how to diagnose and treat it properly. The aim of this article is to review the literature on the clinical, complications and treatment of dermatomyositis in breast cancer. A search was made in electronic databases, including a total of 34 articles, covering randomized clinical trials, meta-analyzes, original descriptive and analytical articles and case reports. Dermatomyositis can occur before, during, or after breast cancer. Pulmonary complications are frequent, and they can be lethal. Dermatomyositis increases the complications of radiotherapy and mortality in patients with breast cancer. The pharmacological treatment consists of glucocorticoid application at doses according to the patient's need. MÉD.UIS. 2018;31(2):41-7.

Complicaciones postquirúrgicas en intervenciones correctivas de labio y paladar hendido en pacientes pediátricos de un hospital de tercer nivel en Bucaramanga, Colombia 2013-2016 / Complications following surgical treatment of cleft lip and palate in pediatric patients of a third-level hospital in Bucaramanga, Colombia 2013-2016

Resumen Introducción: las hendiduras orofaciales son las malformaciones congénitas de cabeza y cuello más frecuentes en el mundo, con gran importancia epidemiológica por su alto impacto sobre la calidad de vida de la población. Este impacto está dado en gran parte por la presencia de complicaciones postquirúrgicas, por lo que es importante conocerlas, con el fin de aplicar estrategias de prevención o de corrección temprana. Objetivo: identificar las principales complicaciones posquirúrgicas de la cirugía correctiva de labio hendido, paladar hendido o ambos, en un hospital de tercer nivel en Bucaramanga, Santander, Colombia. Materiales y métodos: estudio observacional descriptivo de corte transversal. Se obtuvo la información de los registros de historias clínicas médicas, de pacientes cuya intervención quirúrgica fue realizada durante el período de enero de 2013 a diciembre de 2016. Resultados: se obtuvieron registros de 55 pacientes. La presentación conjunta de labio y paladar hendido fue la anomalía craneoencefálica más frecuente (70,9%). La complicación más frecuente fue la fístula oronasal (23,9% de pacientes con compromiso del paladar), seguida por la dehiscencia de la herida quirúrgica (3,6%). Se encontró un mayor porcentaje de complicaciones postquirúrgicas en el sexo masculino. Conclusión: la complicación postquirúrgica de corrección de labio y/o paladar hendido más frecuente encontrada en la muestra fue la fístula oronasal. MÉD.UIS. 2018;31(2):25-32.

Abstract Introduction: the orofacial clefts are the most frequent congenital malformations of the head and neck in the world, with great epidemiological importance for their impact on the quality of life of the population. This impact is largely due to the presence of postsurgical complications, which is why it is important to know them, in order to apply prevention strategies or early correction. Objective: to identify the main complications following surgical treatment of cleft lip, cleft palate or both, in a third level hospital in Bucaramanga, Santander, Colombia. Materials and methods: descriptive cross-sectional study. The information was obtained from the medical records of patients whose surgical intervention was performed during the period from january 2013 to december 2016. Results: records of 55 patients were obtained. The joint presentation of cleft lip and palate was the most frequent craniofacial anomaly (70.9%). The most frequent complication was oronasal fistula (23.9% of patients with compromised palate), followed by dehiscence of the surgical wound (3.6%). A higher percentage of postoperative complications was found in the male sex. Conclusion: the postoperative complication of lip and/or cleft palate correction most frequently found in the sample was the oronasal fistula. MÉD.UIS. 2018;31(2):25-32.

Conocimientos sobre el virus del papiloma humano y su vacuna en padres de familia de Rivera, Huila en el 2015 / Knowledge of human papillomavirus and its vaccine in parents of Rivera, Huila in 2015

RESUMEN Introducción: la vacuna contra el virus del papiloma humano es la medida preventiva más reciente y controversial para el cáncer de cuello uterino. En 2014 Colombia tuvo una serie de supuestas reacciones adversas ante la vacuna que provocó la caída de su cobertura. Objetivo: describir los conocimientos frente al virus del papiloma humano y su vacuna en los padres de Rivera, Huila. Materiales y método: estudio transversal con muestra por conveniencia de 124 padres de niños menores de 18 años, a través de una encuesta sociodemográfica donde fue medido el conocimiento acerca del virus, su vacuna y el cáncer de cérvix. Análisis cuantitativo por medio de la técnica de frecuencias simples. Resultados: el nivel de conocimiento fue bajo (44,35%); el 43,54% identifican al virus del papiloma humano como agente etiológico del cáncer de cuello uterino; sólo el 7,4% considera útil la vacuna como método preventivo y la vacuna fue aceptada por el 87% de los padres. Conclusiones: El conocimiento del virus del papiloma humano y el cáncer de cuello uterino es bajo y se ve afectado por el desconocimiento de las diferentes estrategias preventivas del cáncer de cuello uterino, así como por la falta de información sobre la acción de la vacuna contra el virus. Sin embargo, la aceptabilidad de la vacuna es alta. MÉD.UIS. 2017;30(1):13-9.

ABSTRACT Introduction: Human Papillomavirus Vaccine is the most recent and controversial step for cervical cancer prevention. During 2014, in Colombia, a series of suspected adverse reactions to the vaccine caused a decline in its coverage. Objective: the aim of this study is to describe the knowledge about Human Papillomavirus and its vaccine from parents of Rivera, Huila. Materials and method: cross-sectional study with a convenient sample of 124 parents whose children were under 18 years old; through a socio-demographic questionnaire, knowledge about issues related to the virus, related to cervical cancer and its vaccine was measured. A quantitative analysis was performed by simple frequency analysis. Results: the level of knowlodge was low (44,35%); 43,54% of the parents identify Human Papillomavirus as an etiological cervical cancer agent, just 7,4% of the parents consider the vaccine as an useful preventive method and the vaccine was accepted by 87% of the parents. Conclusions: the knowledge level of the parents of Rivera, Huila about Human Papillomavirus and cervical cancer is low and it is affected by the ignorance of the different cervical cancer preventive strategies, as well as the lack of information of the action of Human Papillomavirus vaccine. However, the vaccine acceptability is high. MÉD.UIS. 2017;30(1):13-9.